Rheumatoid Arthritis: New Guideline

If psoriatic arthritis affects as many as a million Americans, that's still less than half the number thought to have rheumatoid arthritis, a chronic, sometimes disabling disease whose symptoms can be so similar to those of psoriatic arthritis that the two conditions are often confused. Rheumatoid arthritis is characterized by pain, swelling and loss of function in the joints, plus inflammation of affected joints and other parts of the body. It's fundamentally different from osteoarthritis, which affects an estimated 20 million Americans and is considered to be the result of persistent wear and tear on cartilage and joints.

Drug therapies for rheumatoid arthritis (including disease-modifying anti-rheumatic agents and biologics such as Enbrel) have advanced rapidly in the past few years. This changed landscape prompted the American College of Rheumatology (ACR) to publish new treatment guidelines earlier this month.

The guidelines include updated information about diagnosis, treatment strategies and various drugs' efficacy, benefits and side effects. But at the document's heart are two new principles, says Stanley B. Cohen, incoming president of the ACR Research and Education Foundation. First, the ACR now says that, to prevent what could become irreparable damage to joints, patients should receive early and aggressive treatment, proceeding to still more aggressive therapies if they don't improve within three months. Second, Cohen says, the guidelines reflect the rheumatologists' group's consensus that nearly every rheumatoid arthritis patient should be under the care of a rheumatologist -- who, as a specialist, can keep current with developments and feel more comfortable with new therapies than a general practitioner might. The broader-based Arthritis Foundation makes no recommendation about what kind of practitioner should treat rheumatoid arthritis.

The document "Guidelines for the Management of Rheumatoid Arthritis" is available online at www.rheumatology.org.

-- Jennifer Huget